Despite the fiasco that the Senate has made of things we are now faced with a simple question: what now? We know we aren’t going to get what we want. In fact we knew that the minute that single payer was off the table, but now we’ve got even less to be enthusiastic about, or have we? It seems that people have their views on this matter and are expressing them everywhere. Andy Stern has told us “[d]on’t [k]ill the [b]ill. Fix it.” Howard Dean has told us this “wouldn’t bring real reform.” The list of people who have opinions on this matter include Bill Clinton and Victoria Kennedy as voices of experience. However, there is one person who has been left out of this discussion, and that one person is suppose to be the real reason we’re doing this. The American citizen’s voice seems to get lost in this, but it didn’t get lost in an article I read on Talking Points Memo. In it we read the following:

From TPM Reader AK …

If I feel abandoned, it’s not by Obama and the Democratic party, it’s by those on the left advocating to kill the bill.

I am unemployed and have a pre-existing condition that requires daily medicines, quarterly doctors visits and an annual test. I am on COBRA, which runs out mid-2010, when I will have to find new health insurance. I will need to purchase some kind of health insurance, assuming I can find provider who will insure me

I don’t pretend to understand all the intricacies of the health care reform bill, but I do read a lot. From what I can glean, if the bill passed, I would be able to find health insurance because I could not to be turned down due to my pre-exisiting condition. And based on my income at the moment, my premuims [sic] would be subsidized.

Am I disappointed in the reform effort? Yes. I believe in single payer. I was terribly disappointed the Medicare buy-in for 55 and older was dropped, not because I give a rat’s ass about Lieberman or the political wrangling involved, but because I am two years shy of 55 and I would have loved to be able to tough it out on the private market for a little while longer knowing Medicare coverage was just around the corner. Believe me, it’s scary being 52 and unemployed with a medical condition. Any form of security is vital.

My case is not unique or unusual. In fact, it is common. I am one of thousands if not millions with the same issues that this bill would affect. And when I read or hear people from the left arguing against the bill that would likely provide me and people like me with some modicum of security because the bill doesn’t accomplish everything they had hoped it would or it doesn’t help every last person or the insurance industry will benefit, I do feel abandoned.

Have we become so wrapped up in ideology or pragmatism that we’ve forgotten about AK?

None of us are truly happy with this bill. I stopped feeling enthusiasm when the Public Option was removed. In my view the fact that Medicare was being expand wasn’t enough. As I saw it no Public Option meant no bill. The choice between Public Option and expanding Medicare is now gone. So the question remains: is this a good bill?

[T]here’s now a tactical alliance between conservative critics of “ObamaCare,” who view the regulation and subsidization of private health insurers as “socialism,” and progressive critics of the legislation who view the same features as representing “neo-feudalism.”
To put it more bluntly, on a widening range of issues, Obama’s critics to the right say he’s engineering a government takeover of the private sector, while his critics to the left accuse him of promoting a corporate takeover of the public sector. They can’t both be right, of course, and these critics would take the country in completely different directions if given a chance. But the tactical convergence is there if they choose to pursue it.

Kilgore’s words give me reason to pause and wonder if perhaps we’ve all become so caught up in idealism or pragmatism that we’ve lost all sense of what this is about. Are we really Obama’s doormat, or is this the best chance we have to make progress? Without knowing what’s going to be in the bill I can’t know if it’s worth passing, but I do knowAK thinks it might be.

This is not an exercise in self-aggrandizement, but a true story, and one which has formed the basis of my belief-set on this issue.

In 1971, while living and working in England, I developed acute nephritis, due (believe it or not) to atmospheric pollution. I spent 13 weeks as an in-patient at a hospital, undergoing every treatment possible by specialists brought in from all over the country, because my case was so unusual. Bear in mind, I’m a Yank, not a Brit.

13 weeks! Imagine that happening in this country? As an employee, though a foreigner, I paid my taxes like everyone else. Those taxes proved to be the best dime I ever spent.

The cost to me for those 3 months under hospital care? ZERO! My outpatient cost for the ensuing months -- ZERO.

I cannot tell you how disappointed I am in the current Senate proposal. I don’t support it, and here’s why.

Rightly or wrongly I believe that once any bill is signed into law it will take an act of God to improve upon it. Elected reps who oppose reform will be emboldened by its failure to bring about real change, and the industries will put even more energy into preventing further reform. I see this matter stagnating for many, many years. That is not acceptable.

SCHIP and SS are the perfect examples of how domestic programs became expanded because people got use to the benefits and wanted more. I don’t think this ends the cycle but begins it based on past history.

Most Americans view legislation like this in a binary way. Those who opposite do not see a win to embolden them believe me. Once law gets passed it will be a win and basis for further progress.

That story makes me weep in frustration with our country! I have only one biological child-- he is the most important person to me. I have told him I’d like him to consider leaving the US for Western Europe/Canada --someplace with humanity. I mean it. He should leave this backward place for somewhere where his life will be better.

It’s a sad irony. My grandparents endured severe hardships to get here from Poland and Tsarist Russia, where they would have perished. Now, the second generation advocates returning, if not to those places, to the Old Country.

And the Repubs say our NHS stinks, it’s not perfect but it still works.

My father will be 87 this month, he suffered a stroke in 99′, he gets all his help, caregivers, cleaners, laundry and medication free. He receives about 45 Pound a week, he tips his caregivers and the other people who work for Social Services because they don’t earn very much for all the work they do.

I don’t have to worry as much about him now, even though I’m thousands of miles away, he is being taken care of. So much for the Repub lies.

As regards the blog, I guess the good news for many of us is that we’ll be eligible for expanded Medicaid coverage when the need arises. But once upon a time I managed a large clinic, and experienced the deliberate tactic of swamping the appointment schedules in order to prevent Medicaid patients from being seen. I imagine that is a broad practice, and adding several million more to the rolls is not likely to improve the situation. I see it as a lose/lose. Another reason why I argue against the present proposals with the assumed default to a Medicaid-type of coverage for those who can’t afford private coverage.

Here in Japan I have the same National Insurance plan as my Japanese hubby. I pay only 30% of my regular hospital out patient bills. MRI and CT’s are a litte more expensive but still very cheap.

The only thing not covered are major diseases like cancer, you have to have a separate, private policy for that. We pay about $100 each every month and are covered. I just can’t understand the obstruction and gutting of your HCB, I have out of work and sick friends in your country, it really makes me mad too.

So Bart Stupak (D-MI-01) not only opposes the abortion “compromise” that’s allowed the Senate to get to 60 votes for passing it’s version of the health care bill, but he’s been working with the Senate Republicans to undermine that “compromise.”

That sets up an interesting question. How many of the 64 Democrats who voted with Stupak the first time around were just out looking a freebie “conservative” vote, thinking it’d be killed in conference, are going to stick with him if he looks to block the Nelson deal? If Stupak holds 45 or so of his 64, he’d have the numbers to start dictating terms, and Stupak becomes the new Nelson.

And what will Nelson’s response be? Ordinarily, you could expect a Senator whose deal was blown up (especially one who’s been demanding no changes be made to it) to dig in and hold the line. But might Nelson’s fall-back position be that there simply must be some abortion-blocking language in the final product, and if it has to be Stupak’s, well, so be it?

In hindsight — especially in hindsight — allowing that House vote on Stupak appears to be an enormous mistake. I say in hindsight, even though it certainly showed every indication of creating gigantic problems in the future, because it was very simply never 100% knowable whether the bill could have gotten out of the House without allowing it.

But either way, Democrats who simply went along for the ride on that amendment, looking to burnish their “conservative” credentials but all the while secretly thinking it’d disappear in conference, have instead ended up emboldening Stupak to the point where allegedly he felt safe working with the Senate GOP on engineering a deal that endangers this bill all over again.

How many of them were there? No one can say for sure, but we may find out soon enough, if the Nelson language stays intact in whatever package is presented to the House for approval. My guess is that Stupak could lose about half of his 64, and that’d be enough to get the bill through. But don’t expect many of them to own up to flip-flopping on abortion. They’ll have the luxury instead of perhaps saying they’re happier now with the absence of the public option from the bill — unless, of course, they’re pro-public option and anti-abortion.

But even then, it’s not likely you’ll have seen the last of the Stupak amendment. Stupak, I would guess, is now the new Hyde amendment, and that means you’re likely to see it offered as the motion to recommit on appropriations bills (and maybe some others, depending on subject matter) for the foreseeable future.

If so, the repercussions of the late evening decision to allow that vote to go forward in the name of expediency may be with us for a very, very long time.

That’s about $22 billion more than the bill was originally expected to cost, before the new changes--including nixing the public option--were offered to the bill. Democrats replaced the public option with a new plan to allow national or multi-state, non-profit insurance plans, regulated by the federal government, to sell insurance on state exchanges.

The CBO has concluded that, on average, premiums will be the same as they would have been if the Senate had the public option, but that the public option saved the federal government more money by putting downward pressure on the premiums of low-cost private plans, which will be heavily subsidized.
The bill remains a big deficit slayer--$132 billion in the first 10 years. Over the next 10 years, CBO warns all estimates are very uncertain. But here’s a key conclusion: “CBO expects that the legislation, if enacted, would reduce federal budget deficits over the ensuing decade relative to those projected under current law--with a total effect during that decade that is in a broad range around one-half percent of GDP.”

Senior Democratic aides are suggesting that the bill could reduce the deficit, compared to deficits projected under current law, by as much as $1.3 trillion.

You can read the report here (PDF), and a summary on the CBO’s blog here.

Thanks for posting this, Scherz. Here’s the point that I found extremely interesting in that article: “The CBO has concluded that, on average, premiums will be the same as they would have been if the Senate had the public option, but that the public option saved the federal government more money…”

If that is true — that the premiums will be the same as they would have been if we had the public option — then this plan sounds pretty damn good to me. The whole point of the public option was to keep premium prices down. If they’re managing to do that anyway….then what’s all the screaming about?

One Premium, Two Checks: How Abortion Will Be Paid For Under The Nelson Compromise
In the House health care bill, consumers who receive federal premium subsidies would be forbidden from buying any insurance policy that covers abortion. That provision--the so-called Stupak amendment--threatened to blow up health care reform. Originally, it’s the language Sen. Ben Nelson (D-NE) wanted to see in the Senate health care bill. In the end, he didn’t get that.

But what he did get might still draw the ire of pro-choice activists and legislators. According to a senior Senate leadership aide, under the Nelson compromise, “[i]ndividuals receiving subsidies will have one premium that they pay with two distinct transactions.”

Put another way: If you’re buying insurance with help from the government, and the policy you want to buy covers abortions, you have to write two checks (or authorize two credit card transactions, etc.) for your plan. If the plan costs $1000 a month, and the insurer plans to sequester $50 to put into a pool that covers abortions, you have to make one payment of $950 and a separate payment of $50.

So far, leading pro-choice Democrats in the Senate say they can abide by that. Here’s Sens. Barbara Boxer (D-CA) Patty Murray (D-WA):

We said all along that we wanted to ensure there was a firewall between private and public funds — this compromise achieves that.
We said we would not accept language that prohibited a woman from using her own private funds for her legal reproductive health care — this compromise meets that test.

And we said we would stop Stupak — which we did. Let’s be clear — we were both much happier with the Capps language and the language in the underlying bill.

But compromise was necessary to get a health care bill for the American people, and this compromise achieves that.

We know that Republicans are already gearing up their opposition to the compromise on pro-life grounds. And Rep. Bart Stupak (D-MI) may be gearing up to oppose it. But what will other pro-life and pro-choice Dems in the House say? We’ll let you know as reactions crystallize.

Snowe Clinches Deal To Turn Logic On Head
After months in which the Senate health care bill was held up over efforts to find some form in which she would agree to sign on to it, Sen. Snowe (R-ME) now says she will oppose it because it is being “rushed.”

Umm… well yes, but I’m not sure how to show you via this medium. Hard to explain, but I’m not sure it will work. If you want to email me I can show you what the source code looks like. Send me one to [email protected] and I’ll send you the source code from my other email addy. The originpoint one is a “screening” email if you will. So I don’t much care where it gets posted.

It might be more beneficial to have AdLib, nellie, or K7 (group vote) decide or at least clarify the rules of the road. There are some things I yet know how to do, but would like to know how to do. Seems to me, that any of us who have been determined to be legitimate Planetarians should be on the same page.

Harry Reid finally has his entire caucus on board for a health care reform bill. The 60-vote bar has been reached (until such time as Lieberman feels the spotlight drifting away, so who knows for sure). Truth be told, this sticking point on abortion coverage was a bigger deal than most people probably realized. It was a real threat to passage of a bill, so the agreement reached last night with a handshake and announced this morning is not mere window dressing.

What were the elements of the compromise on abortion? We’re still learning the specifics, but Think Progress’ The Wonk Room is reporting that there’s language in the bill that expressly provides additional monies to Nebraska (Nelson’s state) for Medicaid funding. I’m not familiar enough with the legislative language or Medicaid funding mechanisms to confirm that’s what the provision is intended to do, but given Nelson’s publicly expressed concerns about reform’s impact on his state’s budget it certainly seems plausible.

Sen. John Cornyn (R-TX) thinks so, too. In an entry on his Facebook page which he also tweeted, Cornyn links to the The Wonk Room post and acidly writes: “Apparently this was persuasive to Senator Nelson.” (Wry-humor points to ABC’s Jake Tapper, who tweets: “first time ive ever seen a Republican senator link to a ThinkProgress blog post.”)

For my money, increased federal Medicaid subsidies for a particular state ranks pretty low along the spectrum of pork barrel politics. Is it good policy to single out one state for special treatment? Probably not. Does it amount to the sort of sleazy special interest politics that awards fat federal contracts to major campaign contributors? Hardly. For those who would equate the two, what planet do you live on?

Reading through the comments on Cornyn’s Facebook page, you’d think Nelson had walked in through the front door of the Treasury building and stuffed his pockets with Ben Franklins on his way to the Caymans — or, as you’ll see below, had turned Christ over to the Romans:

* “Wow, like 30 pieces of silver!”

* “Sen. Nelson, word is you will sell your “yes” vote, and your credibility, for some Medicaid enhancements. If you chose to vote yes on this bill, know that you will have lost any credibility you may have had in the past for 30 pieces of silver. Thanks Judas.”

* “Yes, Nelson is a man of his convictions, which he will gladly SELL to the highest bidder!”

* “I’m sick of congress SELLING OUT the nation for their own selfish interest!!! Landrieu has done it, Nelson has done it. I say vote every last one of you out of office!!!!! You are destroying the nation!”

That last one is what got me. His own “selfish interest”? Trying to secure more money to help his state pay for health care for poor people? Really? It is just like the recriminations Landrieu received for bargaining for more federal dollars for her home state, and equally mystifying. Well, mystifying is overstating it. Equally dismaying.

I guess poor Americans should be thankful that the health care system is so badly broken that middle class voters and corporate employers are affected, because clearly they’d be getting no relief otherwise. When a significant segment of the country considers health care funding for the poor to be on par with bribery, and finds a comfortable home in one of the major political parties, we still have a lot of work left to do.

You know what? Abortion aside for a moment-- and I mean JUST for the moment-- what Nelson did for his state…Is it really so terrible? That’s what Senators do: Work for their state. In CA, Medicaid is broke.NO FUNDS! Maybe DiFi and Boxer need to hold the country hostage too. Look, I’m only being partly serious. But if Nelson and Landrieu can do it, what’s to stop every Senator?

Honestly that particular part of it isn’t really phasing me. Normally it might, but now that the Public Option is out I’m sort of just watching this unfold without much anger. Lieberman used up every last ounce I had. 😐

Yes LIEberman and Nelson deserve some anger. Where is the anger for the 40 Senators who have been lying about and blocking this bill even before it was written. Where is the disgust with all the front groups who have been spreading disgusting lies?

The expression “beneath contempt” fits them perfectly. They really are beneath my contempt, but the Blue Dog Dems are not. I just wish the rest of the country sees what they are doing and punishes them at the polls.

I wish I could say the same. I have deep reservoirs of anger still left. In fact, last night I decided I would limit my viewing of Rachel Maddow. She does a great job of uncovering the worst of Reptilian shit, but I am becoming poisoned.

The Devil (i.e. Insurance Corporations) offers, “I will cover 30 million of your uninsured and all you have to do is give me your soul.”

That “soul” being our financial slavery to Insurance Corporations and they will then have the U.S. government as its “minion” to enforce this on everyone who lives in America.

It reminds me of Bush’s tax cuts, where the wealthiest received millions and the average person got $400 or something and thought, “Cool!”

Yes, there are people who need health insurance today who can’t afford it and should have it today. That’s not in dispute among true progressives whether they favor or oppose the current bill.

The difficult issue is in trying to look ahead and imagine where all of us will be in ten years if this passes with terms similar to how they are now.

According to the provisions as they’ve been described, insurance companies can raise their rates at will. The bill won’t kick in for a number of years, by then they could have doubled the rates from today and all this financial assistance could be absorbed with all of us, including many of those 30 million, facing premiums we still can’t afford.

This could be a bait and switch by the insurance companies, they have shown how clever they are to get around regulations and the intent of laws, without strong regulation, could the benefits to many Americans from this bill just be conceptual or temporary?

And if the provision stands that allows them to cross state lines to sell insurance and they can all set up shop in Texas or another state that has the most Insurer friendly/consumer unfriendly provisions and oversight, no matter what state you live in, you will have no recourse and will have to abide by how Texas protects insurers.

This is what you do to make a big steal. Offer the mark something they can’t refuse in exchange for something huge they would never otherwise give you…then steal back what you gave them.

I am not as confident as others that the insurance companies will play by the rules or at least the intent of the rules. That’s my concern, that these insidious insurance companies are already calculating on how they can widdle away at the benefits Americans would be given by this bill.

I do not think that the bill that would come out of conference with the House will be much changed from the Senate version, out of fear Lieberman or Nelson will jump ship and scuttle the whole thing. So, my bet is that what the Senate bill is will pretty much be what the final bill is.

If it passes, I will at least take comfort in the near term that people who need insurance desperately are going to get it and Obama and the Dems in Congress will chalk up a win while the GOP retreats back in its coffin to wait for the next full moon.

The fact is if it was not always single payer or everyone could buy into the public option it is a deal with the devil.

You have to look at the final PO that resulted where 10-20% of people would have become newly covered by a public plan that could not use Medicare rates. Whereas it was still a 80-90% a deal with the devil.

Add on the non-profit government administered plans for each state that is close to what Federal Employees get and in reality you have something close to the PO just without the government run language.

The same thing goes with premiums increases from both plans which were not going to bend the curve much. Like I said in a previous post universality of everyone who can paying premiums bends the curve better than the current PO by far. In fact there was a good chance the PO could be used as a dumping ground for patients with preexisting conditions and older patients. Of course I would argue the public coverage would be better even though it could be more expensive.

I share your concerns. Indeed, even now as we approach the end I am wondering what the real result will be. My hope is that for all that may go wrong there will be some good that comes from this. I have to say that my head still tells me this bill isn’t the right one to pass, but my heart still thinks about the people who might receive some benefit from this. I’ve not been this torn about something in a long while.

Ultimately I wanted to stress that no matter who we are, or where we fall within this debate, let’s try to remember the voices of those who are praying for help. I do hope they find it.

As I posted the other day, that’s what I have decided as well, AdLib. I find small (very small) rays of sunshine, but no one can tell me it’s not still raining. It is very hard to keep a still upper lip.